ABSTRACT
La neumonía herpética es una rara enfermedad que afecta casi con exclusividad a personas con un déficit de inmunidad. Con frecuencia tiene un desenlace fatal. Su aparición está descrita en los primeros 2 meses luego del trasplante pulmonar, pero en nuestra experiencia se evidenció después de los 10 meses, 1 año y medio, 8 y 19 años. Describimos los hallazgos tomográficos detectados en 4 pacientes con trasplantes pulmonares que cursaron neumonía herpética. Presentaban fiebre, tos, expectoración y disnea, con empeoramiento progresivo de su clase funcional, y todos fallecieron tras la aparición de la enfermedad. El diagnóstico histológico se realiza mediante lavado bronquioalveolar o biopsia transbronquial, con posterior tinción con hematoxilina-eosina y/o marcación inmunohistoquímica. Los hallazgos tomográficos destacados fueron: opacidades en vidrio esmerilado de distribución parcheada, consolidación del espacio aéreo, derrame pleural y bronquiectasias. Debido a su baja frecuencia y mal pronóstico, es importante conocer y tener presente esta entidad en personas trasplantadas de pulmón para no demorar el diagnóstico y actuar lo más rápidamente posible.(AU)
Pneumonia due to herpes simplex virus type 1: A difficult to diagnose condition with a poor prognosis in lung transplants Abstract Herpetic pneumonia is a rare disease that mostly affects people with immune deficiency whose outcome is frequently fatal. Its appearance is described in the first two months after surgery. In our experience it was evidenced in the post transplant apart since 10 months, 1 ¢ years, 8 years and 19 years after the transplant. We described the CT findings detected in 4 lung transplant recipient that had evolved with herpetic pneumonia. Patients presented fever, cough, sputum and dyspnea with progressive worsening of functional class, four died after the disease. The histological diagnosis is made by bronchoalveolar lavage or transbronchial biopsy with subsequent staining with hematoxylin - eosin and / or immunohistochemistry procedure. The highlighted CT findings were ground-glass opacities patchy distribution, airspace consolidation, pleural effusion and bronchiectasis. Due to its low frequency and poor prognosis is important to know this entity in lung transplant recipients to avoid a delayed diagnosis and treatment.(AU)
ABSTRACT
La neumonía herpética es una rara enfermedad que afecta casi con exclusividad apersonas con un déficit de inmunidad. Con frecuencia tiene un desenlace fatal. Su aparición está descrita en los primeros 2 meses luego del trasplante pulmonar, pero en nuestra experiencia se evidenció después de los 10 meses, 1 año y medio, 8 y 19 años. Describimos los hallazgos tomográficos detectados en 4 pacientes con trasplantes pulmonares que cursaron neumonía herpética. Presentaban fiebre, tos, expectoración y disnea, con empeoramiento progresivo de su clase funcional, y todos fallecieron tras la aparición de la enfermedad. El diagnóstico histológico se realiza mediante lavado bronquioalveolar o biopsia transbronquial,con posterior tinción con hematoxilina-eosina y/o marcación inmunohistoquímica. Los hallazgos tomográficos destacados fueron: opacidades en vidrio esmerilado de distribución parcheada, consolidación del espacio aéreo, derrame pleural y bronquiectasias. Debido a su baja frecuencia y mal pronóstico, es importante conocer y tener presente esta entidad en personas trasplantadas de pulmón para no demorar el diagnóstico y actuar lo más rápidamente posible...
Subject(s)
Humans , Pneumonia , Lung , Histology , Tomography , TransplantationABSTRACT
Improving access to CD4 testing in resource-limited settings can be achieved through both centralized and decentralized testing networks. Decentralized testing models are more suitable for countries where the HIV epidemic affects a large portion of rural populations. Timely access to accurate CD4 results is crucial at the primary level of the health system. For the past 7 years, the Institute of Human Virology of the University of Maryland School of Medicine has implemented a flexible and sustainable three-phase model: (1) site assessment and improvement, (2) appropriate technology selection with capacity building through practical training and laboratory mentoring, and (3) quality management system strengthening and monitoring, to support accessibility to reliable CD4 counting at the point of service. CD4 testing capacity was established in 122 of 229 (53%) laboratories supported in Nigeria, Uganda, Kenya, Zambia, Tanzania, and Rwanda. Among those in rural settings, 46% (69/151) had CD4 testing available at site level, with a functioning flow cytometer installed at 28% (8/29) and 50% (61/122) of level 1 and level 2 sites, respectively. To strengthen local capacity, a total of 1,152 laboratory technicians were trained through 188 training sessions provided both on-site and at central locations. The overall quality of CD4 total testing procedure was assessed at 76% (92/121) of the laboratories, with 25% (23/92), 34% (31/92), and 33% (30/92) of them reporting excellent, good, and satisfactory performance. Balancing country-specific factors with the location of the clinic, number of patients, and the expected workload, was crucial in adapting this flexible model for decentralizing CD4 testing. The close collaboration with local governments and private vendors was key to successfully expanding access to CD4 testing within the framework of HIV care and treatment programs and for the sustainability of medical laboratories in resource-limited settings.
Subject(s)
CD4 Lymphocyte Count , HIV Infections/diagnosis , Africa , CD4 Lymphocyte Count/economics , CD4 Lymphocyte Count/instrumentation , CD4 Lymphocyte Count/methods , Developing Countries , HIV , HumansABSTRACT
Human herpesvirus-8 non-sexual transmission occurs primarily from mother-to-child. The viral load in saliva is higher than in other human fluids. Moreover, there is evidence that bloodsucking arthropod bites induce an inflammatory/immune response that facilitates viral replication. We aim to explore possible risk factors in mother-to-child HHV-8 transmission associated with traditional methods which involve the use of saliva to relieve the irritation and skin reaction caused by arthropod bites. We administered questionnaires to 2244 children from several African countries and Italy. Descriptive statistics and logistic regression were used in the analysis of the answers to evaluate the relationships between the use of traditional methods and other risk factors. The use of traditional methods is high in Cameroon (63.0%) and Uganda (39.9%), intermediate in Senegal (26.7%) and Italy (21.7%), low in Madagascar (6.7%). Statistical analyses show significant direct relationships between the use of traditional methods, skin reactions to the bite and their duration in Cameroon, Uganda and Senegal. The use of saliva and herbs applied by the mothers on the child's skin, is a common habit in Africa. If this practice plays a role in the HHV-8 transmission, then, it could provide the basis for interventions capable of reducing the health impact of the infection in children in tropical areas.
